Effective communication between patients and healthcare professionals is important for positive clinical outcomes. However, patients with special communication handicaps [e.g., limited English proficiency, hearing impairment, aphasia, intubation for mechanical ventilation (MV)] have a limited number of tools to help them communicate their needs and physical status to their caregivers and family. As a result they can experience frustration, anxiety, panic, sleeplessness, fear, isolation, and insecurity, all of whic can have a negative impact on outcomes. Vidatak previously developed the EZ BoardTM as a manual aide that in published studies has shown some value in helping MV patients communicate more effectively. However, this tool has a limited inventory of the words, phrases, languages, and pictorial representations and therefore cannot meet the needs of the majority of impaired patients. This proposed STTR project will overcome most of these limitations by developing a digital tool, based on iPad technology that incorporates via software the flexibility to meet the usability requirements of a broad range of critically ill patients. The long-term goal s to commercialize an easy-to-use, versatile, patient-centric communication device that can achieve effective communication for critically ill patients and thereby impact outcomes. In Phase I the feasibility of developing such a device will be demonstrated by achieving the following aims: Aim 1) To define a) the human factor requirements and b) the end user needs of MV patients for the design of a digital communication device, and Aim 2) To build an alpha prototype and evaluate its functionality and usability with MV and LEP patients in an acute inpatient critical care unit. Phase II will extend the Phase I efforts by refining the user interfae and expanding the range of software options to serve different categories of patients. The commercial opportunity lies in becoming the standard of care by facilitating effective communication to improve the care and comfort of patients in critical care units.